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The Left Atrium
Contents
• Herons and the human side of medicine [PDF] • Elusive inspiration [PDF] • The flight of the Butterfly [PDF] • Confidentiality [PDF]
As Robert Bly recounts it,1 the Japanese, whose society has honoured the warrior for centuries, tell a story about a pond that had lost its king; uncertain about what to do, the pond's inhabitants finally elect a heron (an emblem of the warrior) to be king. The problem with this arrangement soon becomes apparent: the heron eats up everyone in the pond. Sometimes in the moments before I doze off in research rounds, stymied by signals, mesmerized by messengers and numbed by Northern blots, I wonder if the herons have taken over medicine. But any such notion may be dispelled by reading A Piece of My Mind, a collection of essays from the Journal of the American Medical Association. These essays are a beautiful set of epiphanies about the human side of medicine. There is the junior student sent to draw blood from a baby who was burned in a home fire. The child is horribly burned, difficult to draw blood from and suffering terribly from repeated medical interventions. After many attempts the student succeeds in drawing the blood and tries to leave the room. He has been trying to leave ever since. There is the wife of the cancer patient who allows him to order her to stand in a corner when they have a disagreement. As she says, "We both know it's a macabre charade, but I go there happily to restore a smidgen of his lost power." There is a story called "A mutual investment company" in which a woman going for a routine Pap smear expresses her appreciation for her physician, Dr. Goodwin, who takes time, listens to her and treats her like a human being. She concludes, "Thank you for investing in me. Please know that I have invested in you too." There is not a story in this collection that did not touch me. Perhaps the ethos of these short pieces is best summed up in a story called "Last rounds," in which a physician watches his physician-father die of lung cancer. The writer concludes, "Medicine is still very much alive, but it lives not so much in the frontiers of the new technology, which too often only painfully prolongs the entrance of death, as in the hearts of physicians." Perhaps he could also have added: "in the hearts of nurses and other health care workers, and particularly in the hearts of patients." But, despite the reassurance I derive from this book, I begin to worry again. I think I can see, or I fear, where the herons of molecular biology might lead us. They have a vision of achieving complete victory over human disease by understanding exactly how the body works as a machine, from genetic code to the details of subcellular functioning. They have a program and the technology necessary to implement it. Who can enunciate a vision that is clear, comprehensive, simple and inspiring for the whole of medicine, including its human side: a vision that is neither arrogated by technology nor the equivalent of motherhood and apple pie for everyone? We need a plan that incorporates our humanity and is oriented to the future. Most important, all aspects of such a plan must be subject to the scientific method of testing hypotheses and learning the most when our predictions are proved wrong.2 Can we really test predictions about the long-term effects of kindness? Without that we may feel that we are doing good but we might just be fooling ourselves. Can we really know that Dr. Goodwin's investment in his patient paid any important dividends other than making him late for research rounds?
Tom A. Hutchinson References
Contents
• Herons and the human side of medicine [PDF] • Elusive inspiration [PDF] • The flight of the Butterfly [PDF] • Confidentiality [PDF] Lifeworks Elusive inspiration
The last time I took my 10-year-old daughter to the art gallery, she armed herself against boredom by taking along a book. It was a workbook on drawing; complete with watercolour pencils and a pen, it leads the reader through entertaining exercises intended to unlock a free, gestural style.1 The exhibition we were going to see was Elusive Paradise, which showcases until May 13 the ten invited contestants for the National Gallery of Canada's newly minted Millennium Prize. Curated by Diana Nemiroff, this international competition proposed the theme of Arcadian visions on the edge of the 21st century. What is the contemporary artist's view of landscape, of nature, of our lost earthly paradise?
The first work we examined was a set of four sculptures by Liz Magor. These include Hollow, a replicated log that houses a sleeping bag, and Burrow, an intensely claustrophobic variant of the same. Nature is presented uneasily as refuge and hiding place. Stores consists of bags of carrots and potatoes stashed behind sheets of building material. The carrots were sprouting; we considered whether the artist intended this. I attempted a commentary on the forces of nature: renewal and growth. "But won't it go mouldy?" my daughter pointed out. Oh. She pulled me over to Chee-to, a pile of stones imperfectly concealing a cache of cheese snacks. "Are these rocks real?" We tapped one while the guard wasn't looking. No. "But are the Cheezies real?" It seemed so, yes. We were getting the point, or one of them: a loss of distinction between the natural and the artificial. It's an aspect of life we've noted many times, frequently in the grocery store.
Feeling blasé, we moved on to Jana Sterbak's ironic Oasis, a Faraday cage constructed from woven stainless steel, an unlivable refuge from one of the deeper forces of nature, electromagnetic fields. No comfort there. We looked at Diana Thater's Red Sun, a scary array of video screens projecting the sun's plasma, formlessly. And at an equally formless set of pieces by Geneviève Cadieux, in which nature is replicated and amplified, invoking infinity, the unarticulable. My mind was slipping into reviewer mode, churning out phrases to capture the conceptual spin. But my daughter was looking for a place to sit down with her sketchbook.
There was nothing, in her view, worth looking at for very long, not even Shahzia Sikander's ceiling-high veils of decorated tissue paper, which soothingly invoke the garden of the imagination. Yoshihiro Suda's exquisite trompe l'oeil, Tulip and Weeds, a carved wooden flower dropping its petals on a glass table, with tiny wooden weeds sprouting from the floor below, provoked our admiration as well as a disagreement about whether the clipboard on the table and the navy blue jacket slung over an adjacent chair were really part of the installation or a mistake by an insufficiently briefed guard. What is nature, what is artifice? What is art, what is accident? We moved on, weary of riddles.
And I found myself disinclined to intrude further into my daughter's day off school with discourse on the Death of Nature. It is too sad. Worse, she knows about it already. So we sought out Janet Cardiff's prize-winning Forty-Part Motet, a "reworking" of a complex polyphonic composition from the 16th century using 40 loudspeakers and the voices of the Salisbury Cathedral Choir.
This music is, indeed, paradisical. But somehow I pictured Cardiff coming to terms with Thomas Tallis's motet as a contemporary scientist standing before Creation: a sense of wholeness giving way to a complexity too great to comprehend. This technologically enabled performance dismantles the music: each individual voice, assigned to one of the 40 speakers, resists assimilation to the whole at the same time as harmony is required. A metaphor for modern society? I felt divided about what to do: whether to seek the exact centre of the sound, or to travel from speaker to speaker, isolating each voice. (We settled on the middle; my daughter opened her sketchbook on the floor.)
Acoustically, Forty-Part Motet is not always pleasing; at times I felt as if the vaulted exhibition space were replicated inside my skull, a chamber where competing frequencies sometimes painfully collided. But this is, after all, an auditory sculpturing of space. And it is not only a musical performance but a representation of one, generating meanings and questions that belong to conceptual art. The speakers have a humanoid appearance: large heads on spindly trunks with comical feet. The real singers, meanwhile, are bodiless. Other conundrums arise from the setting: the Rideau Chapel, a former place of worship rescued from demolition, now reconstructed in the secular temple of art. High-tech sound equipment and wooden angels make for a strange juxtaposition. Visitors move attentively from speaker to speaker,
reminding me of worshippers progressing through the Stations of the Cross.
What does it mean, that in the judges' opinion a modern Arcadia was best expressed by nonvisual means? Is this a bold escape from old boundaries? Or a defeat for contemporary visual art? As we left the gallery my daughter offered a comment on the whole experience: "Well that certainly wasn't worth $12." Under her arm was the book in which she had drawn, with Quentin Blake's guidance, a pig, a hot-air balloon, a big umbrella over a thin person, a small umbrella over wide people, smoke issuing from cars, chimneys, and people's ears, and various other artifacts of an unselfconscious, animated world. A day or so later I realized that she had, unknowingly, mirrored Janet Cardiff's own advice: "follow what you're interested in, don't look at too much art."2
Anne Marie Todkill References
Contents
• Herons and the human side of medicine [PDF] • Elusive inspiration [PDF] • The flight of the Butterfly [PDF] • Confidentiality [PDF] Room for a view The flight of the butterfly
I pulled out the heart tracing I had just ordered. "Here, kind of an interesting case, what do you think of this ECG?"
"I can't read cardiograms," she said, pushing it back to me without even so much as looking. I was taken aback and failed to capitalize on the moment. A guided tour of basic cardiogram interpretation did not materialize.
"Oh. Okay," I stammered. "You're what, a third year student?"
"No, fourth year, a medical student intern."
Muttering under my breath, I experienced a sudden urge to be rid of her. It seemed already a burden to have her shadow me for the day. I shuffled her over to a weak and dizzy 81-year-old woman who was, according to the nurse, hard of hearing and an overinclusive historian. "Perfect medical student material," I thought, feeling my strain lessen considerably.
As planned, she took a long time to assess the patient. While she recounted the patient's history and described the clinical findings, I struck a pose of boredom mixed with impatience. I stifled a sense of frustration as she struggled with my modest inquiries.
The next patient had fallen and gashed his head. After the student had made her assessment, I went over to the man's stretcher and re-examined him. It seemed to be a straightforward case.
"So you go ahead and suture him up," I said. "I'll carry on, okay?" As I turned to leave I could see the hesitation in her face.
"Uhm ..." she whispered.
"You're comfortable with this, aren't you?" My eyes blinked back incredulity.
"Surely by now you've stitched many times before? Haven't you?"
"Well, actually..."
"Well, what?"
"I'd like to. I would, really." She glanced my way, eyes pleading with me not to pass judgement, and then looked away again. While I couldn't help but wonder how she had fallen so far behind her classmates, in this brief, silent, beseeching moment, I realized that I was peering at a struggling individual. She had joys and trials just like the rest of us; she was human.
Here then was the malleable young mind I had been entrusted to influence. With her only a short while, I had categorized her as unmotivated, uninterested or both. In turn, I had responded with irritation and indifference. Looking at her now, trying to comprehend, I suddenly perceived her as fragile. And I realized that a duty to teach sometimes requires a good measure of generosity. It was time, I reckoned, to drop the tough-guy act. Together, we had some work to do.
"Good," I managed. "Let's get started. I'll put in the first one or two. then you take over while I watch. Okay?"
The patient seemed all right with this, too. I prepped the wound and threw in a couple of sutures, explaining the mechanics of the procedure.
"There, easy, eh? You go ahead."
"Sure, thanks." She smiled, false bravado marking her face. I watched the needle driver tremble as she prepared to puncture the skin. I was afraid that she wouldn't be able to overcome her apprehension, but she persevered.
"Good, that's it, exactly," I said, after she had placed two or three sutures appropriately. "You're okay here now. You finish up, I'll go see the next patient." By leaving her I hoped to project confidence in her abilities, so that she might respond in kind.
I checked her work when she was finished. "Nice job," I said. Then I directed my comments to the patient. "There you go, sir, almost as good as new." I explained how to look for signs of infection and told him to see his own doctor to get the stitches out in a week. As I walked with my student from the bedside I noted, out of the corner of my eye, her sense of relief and satisfaction.
For the rest of the day, I found myself feeling more talkative and willing to teach. The student herself seemed buoyed by success and, like a thirsty wanderer offered a ladle of cool water, eager for more.
We worked together four or five more times during her month with us. I remember one of our last shifts together. "I've just seen a new patient," she said, making eye contact with me. "He's a 29-year-old sheet metal worker with a cut over the dorsum of the PIP joint of his left index. His sensation is intact. He can extend fully, which made me think it was okay at first. But then when I tested his strength, he was weak. I think we need to do a digital block and have a look at the extensor tendon, it's probably at least partly lacerated."
"Ahh," I thought, "well done." I felt rewarded, as if I had witnessed a transformation. She was indeed bright and competent, not at all conforming to my first impression.
Though I never found out what had been bothering the student initially, I wondered if she had been exposed to a bullying style of teaching, a method I had come close to adopting myself. But medical students are not immune to the frailties that strike others and it was obvious that, regardless of the cause, she had suffered a crisis of confidence that had affected her ability to perform.
We learn in different ways, each according to the dictates of brain chemistry and the effects of chance and circumstance. What works well for one student may not for another. But in some ways it seems to me that medical students are delicate creatures. Like butterflies emerging from the chrysalis, they must dry their wings in the sun before flying. And the clinical educator who radiates patience and encouragement may witness the intangible joy of flight, a beautiful thing to behold.
Brian Deady Contents
• Herons and the human side of medicine [PDF] • Elusive inspiration [PDF] • The flight of the Butterfly [PDF] • Confidentiality [PDF]
Copyright 2001 Canadian Medical Association or its licensors |
I had finished seeing my first patient of the day when a medical student arrived late for her first shift in emergency. I said hello, shook her hand and introduced myself. She seemed distracted and, perhaps because she avoided eye contact, I couldn't quite read her. I showed her around and explained how things worked. She didn't smile or ask questions and so didn't strike me as a typical, enthusiastic student.